Abstract
Adolescence is a crucial period for developing certain personality traits that shape a person's behavior throughout life. Each person has a unique set of positive and negative traits that build a person's personality, which remains relatively stable and permanent. It has been a matter of controversy for the last many decades that personality disorders cannot be diagnosed before 18 years, considering the evolving personalities of these young people. However, recent personality assessment models and a growing body of research have proven the existence of personality pathology during adolescence. Hence, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) considers the developmental perspective of personality pathology and emphasizes the presence of maladaptive personality traits during adolescence. The primary purpose of the present chapter is to discuss the recent models of personality assessment and how these models can be applied to adolescents.
TopIntroduction
Personality pathology among adolescents has been a topic of controversy for the last several decades. Clinicians are reluctant to diagnose personality disorders among adolescents considering the developing stage of personality formation, and few traits may remit over time. Personality pathology at an early age can be a precursor of various psychological problems in adulthood; therefore, early identification of personality disorders (PD) among adolescents has gained popularity in recent years. The majority of the patient with antisocial personality disorders have a history of conduct problems during childhood and adolescence; therefore, early identification and diagnosis of personality disorders can give way to early intervention for these problems (Laurenssen et al., 2013).
Identity formation is an essential milestone of the adolescent stage of life, which is influenced by a person's inner experiences, perceptions, and environment around them. The concept of “identity” has been given a deemed importance in the DSM-5 alternative model of personality disorder (AMPD) (Waugh et al., 2017). Identity disturbances have been considered trans-diagnostic factors due to the important role of self and identity in developing various personality disorders. The concept of identity crisis was given by a famous theorist Erik Erikson with its significant relevance during the adolescence stage. This is a critical period when teenagers start developing an individual identity that is different from his/her parents. Individual identity comprises a sense of uniqueness and self-image based on their inclinations and purpose in life, specifying their roles and function in society. Adolescents who successfully attain a coherent sense of self-identity and purpose in life will be able to resolve the identity crisis. On the other hand, incoherence, negative self-image, lack of meaning, confusion, and poor interpersonal adjustment usually results in negative identity formation (Skodol et al., 2015).
Identity confusion or disturbance is the hallmark symptom of different personality pathology among adolescents. DSM 5 describes a life span perspective of personality pathology that incorporates various developmental considerations and integrates identity as an important component (Rodriguez-Seijas et al., 2019). There are several challenges in identifying personality pathology in adolescents, as it is difficult to differentiate the typical adolescent's issues from the behaviors that support the presence of personality pathology. Despite the ongoing controversy and challenges to support the diagnosis in adolescents, ICD-11 and DSM-5 state that the onset of most personality disorders ensues during adolescence. As per DSM-5, the diagnosis of personality pathology may be applied to adolescents in specific scenarios wherein an individual's maladaptive personality traits seem pervasive and consistent. Moreover, they cannot be seen as a reflection of any developmental changes or other mental disorders (Bach & First, 2018; Swales, 2022).
Rationale for Diagnosing Personality Disorders in Adolescents
The accurate diagnosis of PD in adolescents is important, considering the ever-changing pattern of traits and the persistent nature of problems. Most adolescents retain the pathological personality traits for extended up to adulthood and remain relatively resistant to treatment. Thus, the prognosis of PD among adolescents remains poor and causes a substantial burden on society and the health care system. Considering the huge impact of PDs on adolescents and the community, there is a need to have an evidence-based diagnostic system that facilitates the early identification and management of these chronic difficulties (Guilé et al., 2018; Russo, 2022). Benefits of early identification and interventions are manifold such as early intervention of personality difficulties during adolescence is critical to avert the long term consequences of personality pathology as the changes become refractory overtime. Early intervention also has potential of anti- stigmatizing effects of personality difficulties and patient become more amenable for treatment.
Key Terms in this Chapter
Motivational interviewing (MI): MI is a therapeutic approach that motivates adolescents for behavioural change especially among those who are ambivalent about changing their behavior.
Personality pathology: Personality pathology is defined as constellation of pervasive and consistent maladaptive personality traits of an individual that impair his/her socio-occupational functioning.
Alternative model of personality (AMPD): The AMPD is a dimensional model of personality dysfunctions that include presence of five pathological personality traits, such as negative affectivity, detachment, antagonism, disinhibition, and psychoticism.
Dialectical behavior therapy (DBT): DBT is most commonly used therapeutic modality to treat adolescent with borderline personality disorder. It utilizes techniques of mindfulness-based meditations, distress tolerance skills, emotional regulation skills, and interpersonal effectiveness.
Personality difficulty: Personality difficulty can be defined as the presence of sub-threshold personality problems related to interpersonal adjustment; however, the intensity does not qualify the criteria of personality disorder.
Personality: Personality is defined as enduring characteristic ways of thinking, feeling and behaving which remain relatively persistent throughout life.